Susanne Madden: Hello and thanks for taking the time to speak with me. You guys at PCC are always working on the next big innovation and I know you’ll have some exciting things in the works. Let’s jump right in! What’s happening at PCC in 2019?
Chip Hart: Thanks for chatting with us! The first exciting thing on our radar is our WeCare program [https://www.pcc.com/wecare). Your timing on this is really great because we are just about to open up applications. The whole WeCare program started when we realized we constantly meet practices who want to work with us, but only after having chosen a sub-par vendor first. They say, “I wish we’d gone with you because I am 80% Medicaid and I feel like I can only afford the least expensive option.” So many Medicaid practices have this attitude that because they’re Medicaid practices, they don’t deserve to run their practices in the best way possible. My response has always been that it’s the Medicaid-oriented practices and others focused on the underserved that can’t afford to cut corners or do things cheaply.
We routinely meet practices almost daily who say, “I love talking to PCC! You are exactly the vendor we want but… I couldn’t pass up this deal from this other vendor. They’re giving us 70% off if we sign this month,” and we always tell them the same thing: You’re just going to call us next year to say you wish they’d gone with us in the first place. So we thought here is an issue that we want to address, but we also know that the major growth of independent pediatric practice in this country is in the underserved markets. And those markets are being served largely by women physicians, physicians of color, and by women of color in particular. It’s clear that the demographics are very different for pediatrics in the 21st century.
The other thing that’s key to all this is that we’re a Benefit Corporation. Even though our mission is officially “To remove the obstacles that keep pediatricians caring for their patients,” how can we call ourselves a pediatric software vendor and a Benefit Corporation if we only serve those pediatricians who operate in the suburban commercially insured markets? Don’t get me wrong, many of those clients are our bread and butter and that pays a lot of our bills. But the growth in this country is in the underserved markets. There are literally millions of kids who do not have reasonable access to pediatric care and we would like to put an end to that. When we get up in the morning, that’s what we think about doing.
Susanne: You’re tapping into being a mission-focused organization, which is in itself quite exceptional and rare in the EMR space and the IT space. But then there’s your recognition of who your clients are and what it is they’re trying to do. You’re helping to support them by actually shaping and molding PCC to meet the demands of the of the marketplace while also identifying what those demands could or should be.
Chris Forleo: We’re about to launch the program online at pcc.com/wecare. and twice a year we’re going to take applications [in January and June] from practices who serve underserved markets. We’ve asked them to tell us about their practices and visions, and we’re going to choose at least one practice every six months to receive a substantial discount on our services. The purpose is to get this practice up and running and viable! The whole point is to get the practice to a point where they don’t need our discount. We’re still going to give it to them, of course, but the point is to say they’ll be doing so well by then it won’t matter. Now we’re seeing some of our other vendor partners who are stepping up to join us in this effort, such as The Verden Group and IPMSO.
Susanne: PCC is saying that they can actually help you set up your business, and set up your practice to succeed. It’s more than just discounts.
Chris: Yes, but we need to we need skin in the game from everyone. We need everyone engaged on this. We need people committed and focused on achieving a goal. What we’re asking people is—and this is a key part of the application—what are their visions for this practice? What do they see themselves doing in five years, 10 years? What do they want to be as a pediatrician to this community? And here’s the thing. The reason we said we’ll choose “at least one” is because we already know it’s going to be difficult to choose just one. If we get 20 compelling applications, it’s going to be really hard to choose just one. We want to give ourselves the ability to choose multiple practices based on our resources at any given time.
Susanne: Independent pediatricians are so central to what you guys at PCC do so the WeCare program is really an born from that goal. Can you talk to me about that independence piece? Tell me why independence is such an important piece of what you facilitate and why are you so fiercely supportive of the independent pediatrician.
Chip: Well, there are a couple of reasons. Number one, we are convinced that independent pediatricians are vital to the quality of care for kids in this country. Period.
Every study shows that the quality of care that comes out of independent pediatric practices is higher than the care coming from institutionalized medicine. And in non-independent pediatric practices, as in institutionalized or organized medicine, working in pediatrics is routinely demeaning. It is a fundamental contributor to physician burnout. The physicians are not in charge of their own decisions or their relationships with their patients. Maybe that works for other specialties, but pediatricians go into medicine to take care of kids – when they lose control of that part of their work, are we surprised that they are unhappy?
We still have a fair number of clients who are not independent. Frankly, if we were just interested in the finances, we would abandon independent pediatrics. but that’s not who we are and not why we do what we do.
There’s the the technical side, whether it’s being part of the new Carequality network, or doing certain things with immunization registries, or delivering software.
Let me give me you an example. What most people don’t realize is that the overwhel ming majority of alternative growth charts that exist in EHRs are actually bogus. I’m not aware of any other vendors who actually pay to license the Down syndrome growth chart data from the AAP. Most of them have just converted a graph they printed somewhere with their own numbers. And honestly, the data from some of those older Down syndrome growth charts is so bogus that the AAP’s position paper actually specifically says not to use them.
So what do we do at PCC? We do things like invest in the growth chart data from the AAP and hope they’ll continue publishing this important clinical content. It’s possible, and I hope it’s true, that other vendors make similar investments at this point. But I was shocked to learn we were the first and only company to call them.
We also contribute to the AAP from a data perspective, whether it’s helping run studies about HPV, educating patients about obesity, or distributing data about the VFC vaccine.
The other thing we do is less technical and has to do with the open source philosophy of PCC in general. I have hundreds of blog posts, for example, where I publicly share data that almost nobody else can get (or if anyone else does get it, they don’t share it). So, whether we are looking at the relationship between well visit coverage and appointment depth (how far out you make your appointments), to looking at pediatric CPT usage, to the annual RVU calculator we create, we give all of this stuff away. Our competitors (if they even pay any attention to it) keep it to themselves or their customers for the most part.
Susanne: Tell us more about Carequality.
Chip: There are two major health-data sharing networks in health IT. We’ve chosen to work with Carequality. The industry standard for sharing data among doctors until now has been Direct Secure Messaging, which requires you to find another doctor to share data with. So as a physician you have to know a patient has been seen by another physician, you have to contact that physician, and then you have to agree to exchange data. More importantly, that other doctor has to work in a healthcare system or for a hospital that hasn’t effectively blocked that data sharing.
If one of your patients goes to the local ER, that ER doc can usually send you a record of what happened quickly and easily. But the problem is that big “usually.” The large health systems might not allow for such communitcation.
Instead of relying on another physician or having to find them yourself, Carequality allows each practice to become its own hub of patient information. If a patient shows up on your doorstep, you can actually get a clinical history. There will be more to share on all of this in the first quarter of 2019, so watch for that.
We’ve decided to concentrate specifically on our clients who are under the shadow of a local healthcare system so they can share their data to the extent that the hospitals require them to in order to maintain their independence and not be forced onto another system.
Susanne: Is it optional to participate or do all of the EMR companies have to participate now?
Chip: It’s totally optional.
Susanne: And what sort of an ask is it for you? Is this a big undertaking?
Chip: It’s comparable to passing Meaningful Use Certification. There’s a reason why you go look at the list of Carequality Partners they are gigantic. It’s Athena, it’s Commonwell, it’s GE… and then there’s little PCC. From a strategic standpoint, it we can get through the next year, this is going to be the thing that’s going to get pediatricians back on the map.
Chris: Don’t forget that back in August, Carequality and Commonwell reached an agreement to share data. We’re really providing our clients with an opportunity to get the thing they wanted by moving to an EHR to begin with, which is to be able to share data easily with other physicians so that they can provide the best patient care.
Susanne: You’re only as good as the data you have on your patient. I like that PCC is considering the doctor-to-doctor piece, and where does the data reside: Who owns it, and how can it be accessed? I think this touches on a number of different aspects of that. Speaking of which, are patient portals a thing of the past?
Chip: No. Patient portals are part of the future now more than ever and that’s why one of the fundamental themes of PCC’s development for 2019 is Patient Engagement. A huge portion of that is the patient portal.
Everyday on SOAPM we see people complaining about their portals and I’m thinking, “Wow, PCC does that.” Just yesterday on SOAPM someone asked, “How are you getting around the fact that your patients can’t send pictures or attachments to the portal?” The person who responded said, “Oh I have them fax it.” And we’re over here thinking that of course we can do that, of course we can send an attachment. We’re releasing the seventh update right now and you can you take a picture with your smartphone when you are in the exam room and automatically attach to the chart. I know that’s not quite a portal thing, but the fact of the matter is that families are on mobile devices and that is where the communication between a physician and a patient is going.
We actually think the more that you can automate by putting it right in patients’ phones, the better. And the more you can automate your billing that way, the better off you’ll be.
Susanne: Where else do you think patient portals are going?
Chip: The first 20 years of the Internet are now referred to as “Web 1.0” if you wanted to be a web creator, you had to create your own content, put it on the Internet, and hope people would find it. Then the concept of ”Web 2.0” came along with Facebook, Twitter, and the like. In these models, the business creates a framework and users add content. That’s exactly what’s going to happen in the world of healthcare.
Patients will write their own chart notes. As a physician, your job will be to interpret their input—which is really all physicians have ever done, as well as educating patients. Data-capturing is almost demeaning to the physician. That’s not what they’re trained to do. I can teach a fifth-grader to capture data. The fact we’re paying physicians to do it should telling us we’re doing it wrong.
When a patient creates his or her own chart notes through a portal, the patient is is inputting data about chronic disease or preventive care maintenance. That data goes directly to physicians. In turn, physicians are going to be better at managing a couple thousand people at once. Doctors can get asthma screening results from asthmatics, and ADHD medicine reports from teachers, parents, and kids themselves.
Using ADHD as an example, let’s say a kid comes in. He or she gets properly diagnosed with ADHD, and the doctor wants to put the kid on the smallest dosage of medication possible. A child will then be able to check in through his or her mobile device to tell their doctor if the dosage made him or her feel normal today. Now the doctor can zero in on the lowest dosage that works for that patient. The overwhelming number of pediatricians are not interested in medicating kids if they don’t have to. But as a pediatrician you’re probably thinking, “I get one shot at this before not seeing this kid for another couple months.” The physician is left feeling like he or she has got to make a big impact because there won’t be regular contact with the child. And that is what physicians will do in the future, with a portal: Stay in better touch with patients.
When you think about it, a pediatricIan who has 2,500 patients is like the equivalent of being a high school principal who knows every student’s grades. That’s crazy. You have to know what’s happening acutely to each one of those kids every day, but you can’t. That’s what technology is going to let us do.
Susanne: The other piece of this that is great is the proactivity: really being prepared for the visit. It’s all milestones-based, and so much time is taking up during the visit with the physician explaining to the parents where their children should be in terms of development. There’s this component of educating the parents around that, and then they go home and they think of things that are relevant which leads to a call back to the office and maybe even schedule a follow-up visit because now some new concerns have come up. Technology really fascilitates a much more sophisticated level of interaction.
What should we be thinking about in terms of EHRs that we’re not currently?
Chip: The first thing I’m going to say will be to contradict the rest of the healthcare industry. For the future of EHRs and medicine in this country, we have to back up out of this technology race that we’re in and acknowledge the fact that tech won’t solve all our problems.
Using pediatricians as an example, we need to get together and finally draw a line around what is the actual art and science of medicine. One of the problems we have is that if I present a kid with otitis to 20 different pediatricians, I’m going to get 10 to 15 different treatment options. If you go on SOAPM and give symptoms, you’ll get wildly different responses. In order for EHRs to be effective and for us to get to a point where the EHRs are actually serving the physicians and not a third party, we need physicians to get on the same page and be more consistent.
At the very least, we need them to agree on what parts of what they do are science and what parts are art. We need to be able to say that when when a kid presents with X, there’s a group understanding of what proper protocol is. An inordinate number of pediatricians reject Bright Futures as the gold standard of well visits. We will never ever have efficient EHRs in pediatrics if pediatricians don’t have any common agreement as to what quality is.
As long as EHRs exist specifically for the purpose of supporting coding and reporting to a third party for PCMH (or whatever clinical quality measure you’re after), as long as those are the primary reason for EHRs to exist pediatricians will be unhappy. EHRs are not designed to help physicians. So when everyone complains about how bad the EHR vendors are, I remind them that if I designed an EHR that’s actually helpful for them as a physician, they would never buy it because it isn’t MU-certified, it doesn’t run any of the reports that you want for the Feds, and it doesn’t have anything to do with coding. The narrative that they want to run and the continuity of care that they want to manage for a pediatric patient has nothing to do with codes. But the thing is, they need to know this stuff. They need to know if it’s code 99213 or a 99214, as we all know, and it is insane that physicians have to worry about that stuff.
Susanne: That consistency you speak of—physicians coming to a consensus on what quality care looks like—really speaks to the core of these challenges. That, and the primary reasons why EHRs exist is really where the shift needs to happen. If there is one more thing that you would like people to know about PCC what would that be?
Chip: A lot of people don’t understand us right away because they’re waiting for the other shoe to drop. It’s like they’re saying, “What are you not telling us?” Because PCC seems really goofy. We run into this all the time where we’re explaining that our goal is not to make the most money for PCC, our goal here is actually to make these practices better. The first thing I want to tell people is that, no, we’re not a cult and we are real. That’s the first thing.
The other thing, the main thing, is that PCC is legit and we are here to stay.